Read this important new qualitative paper from rural Orissa

Everyone concerned about the prospects of the Swachh Bharat Mission should check out this new paper in BMC Public Health by lead author Parimita Routray and some of the top thinkers in sanitation, available at this link here:

They reach many of the same conclusions as our team did in our qualitative study that we did around the same time as the SQUAT report. In particular, they argue that government latrine construction programs that fail to take into consideration culturally-influenced constraints on demand for latrine use are unlikely to be enough to importantly reduce open defecation:

I am particularly delighted to see the call for more efforts to understand these issues. We don’t know enough yet as a sector about how precisely we can design a rural sanitation effort around these issues that can succeed.

One way that this paper contributes to understanding the culture of purity and pollution around rural sanitation is by documenting how, in the population they study, defecation rituals differ across caste categories and ranks, and within these for men and women. In a detailed table that crosses caste rank by sex and age, they describe, for example, that Brahmin men (the highest castes) wear a special garment to defecate in the open: “This cloth is usually kept outside the living area, away from the main house and away from the reach of children and adults, so that no one touches it.” About high-caste women, they write “For those with latrines, stepping over the squatting pan is considered chuan (i.e. getting impure) and both the body and clothes worn get impure. They are forbidden from entering the house wearing impure clothes.” These rules, the authors describe, do not necessarily apply in the same way to lower castes. But, in so far as people in lower castes aspire to be socially higher ranking, they often seek to emulate the practices of higher castes. One memorable description of this practice is in Valmiki’s Joothan, where the author recounts his regret at neighboring dalits’ abandonment of pig raising — an important economic activity for their livelihood — in an attempt at social mobility.

One aspect of the paper that surprised me was the emphasis on access to water as a binding constraint and solution to the impurities of open defecation. There is a similar conclusion in a recent NBER economics working paper about health effects of sanitation, focusing on the same part of India, rural Orissa — it is also well worth reading. One reason this surprises me is that water is not a constraint that people describe as important in north India, where we have done most of our field research. Another is that in a range of national and international data sources, water doesn’t seem to correlate much with open defecation (that’s an evolving work in progress). Many data sources show that Muslims in India have less access to piped water but are less likely to defecate in the open. Other countries with much worse access to water have much less open defecation, so if improving water access would play a special role in reducing open defecation in rural India it would indeed be a special role, different from what the same intervention would do in other countries and cultural contexts.

But, different places are different, even (especially!) within India. According to the new 2012 IHDS data, 95% of households in rural Uttar Pradesh and 97% of rural Bihar report as their main water source public piped water, a tube well, or a hand pump. In these very large states, about 80% of households with such improved water report defecating in the open. Only 75% of households in rural Orissa report similarly good water supply: 20% of households there report getting water from an open well, compared with less than 5% in rural Uttar Pradesh. So, maybe the water constraints are different.

What strikes me as most important is that the consequences of purity and pollution are so much the same. To me, all of this calls for even more active hands-on work to test out solutions carefully designed — as this important new paper calls for — around the implications of purity and pollution for open defecation in rural India.